AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2690-8794/043
1* IC Universal Legal, Advocates & Solicitors, Mumbai, India.
*Corresponding Author: Rd. Twinkle Dhamecha, Principal Associate at IC Universal Legal, Advocates & Solicitors, Mumbai, India.
Citation: Dhamecha T., Bhavita Prajapati Dr. Anant Marathe (2020) Cryptococcus laurentii (Non Cryptococcus neoformans/gatti) infections – Immunocompromised or Immunocompetent -Who is at risk? – Systematic review J. Clinical Medical Reviews and Reports 2(8); DOI: 10.31579/2690-8794/043
Copyright: © 2020, Twinkle Dhamecha, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 04 September 2020 | Accepted: 10 September 2020 | Published: 17 October 2020
Keywords: cryptococcus laurentii; immune competent; immune compromised; cryptococcus neoformans
Non neoformans cryptococci are usually regarded as saprophytes and human infections are rare. C.laurentii is rare of the non neoformans Cryptococci that can cause human infections. Incidence of human infections with Cryptococcus laurentii and albidus has increased over last couple of decades. The risk factors for C. laurentii infections usually include diminished Cell mediated immunity and presence of invasive devices, while mortality risks increases with CNS involvement and age above 45 years. Clinical manifestations are indistinguishable from other invasive yeast infections. High index of suspicion with any yeasts associated with raised inflammatory biomarkers and presence of neutrophils in the specimen’s stained smear is important in the diagnosis and prompt initiation of appropriate treatment since C. laurentii shows low susceptibility to fluconazole.
We report here a case of lower respiratory infection due to Cryptococcus laurentii in a 57 years old female patient with bronchiectasis. The patient was admitted with complaints of fever, dyspnoea with productive cough. She was on antibiotic treatment. Her chest x-ray report revealed infiltrative opacities at right upper mid zone of the lungs and pleural effusion at left lower zone. The patient later also developed quadruparesis and urinary incontinence.
Non-neoformans cryptococci were previously considered to be saprophytes and nonpathogenic to humans [1] Cryptococcus laurentii is frequently used as a biological means to control fruit rot [1]. Cryptococcus are encapsulated yeast, an opportunistic fungal pathogen that may lead to life- threatening infections such as meningoencephalitis and disseminated cryptococcosis, usually in immunocompromised hosts [2].More than 30 species of Cryptococcus are known, only two species are commonly pathogenic in humans, Cryptococcus neoformans and Cryptococcus gatti [2]. In 2006 there were one million cases of cryptococcal meningitis and 625,000 deaths attributable to the disease worldwide in people living with HIV (PLWH) [3].
An Indian study showed that clinical and environmental C. gattii s.l. isolates had high fluconazole MICs [4]. However, despite these differences in antifungal susceptibility among cryptococcal species, the initial cryptococcosis therapy is the same. The clinical management changes are based on clinical presentation and immune status of the individual patient but does not consider the species involved in the disease [5].
The clinical presentation of C. laurentii is similar to that of C. neoformans but the cryptococcal antigen test is often negative [6], and the organism exhibits decreased fluconazole susceptibility [7, 8]. Therefore, accurate identification of the species is essential for appropriate selection of antifungal agent.
A 57 year female patient of bronchiectasis presented with fever, productive cough with yellow expectoration. She had history of pneumonia few months ago and had taken a complete course of antibiotics. She developed quadriparesis and low back pain since 6 months which progressed to inability to walk since 15 days. She further developed bilateral pedal oedema, anorexia and bladder incontinence.
Laboratory investigations showed raised total WBC counts 28,540/cmm (Normal range: 4,000-10,000), neutrophilia (91%) and thrombocytopenia (111000/ micro litre) with ESR of 48 mm at 1 hr. Other biochemical parameters of RFT and LFT were within normal limits. Serology for HIV antibody was negative.
The patient had productive cough with yellow coloured sputum. Her chest x-ray report revealed infiltrative opacities at right upper mid zone of the lungs and pleural effusion at left lower zone. Patient’s spine MRI shows bilateral sacroiliaitis.
Gram’s stained smear of sputum revealed plenty of neutrophils and moderate number of budding yeasts and no bacteria. The budding yeasts appeared larger in size than candida and had a conspicuous large capsule. Fluconazole was added based on the sputum microscopic findings. Culture report was awaited.
Aerobic bacterial culture was negative. The yeast grown on blood agar and SDA was further processed for ID and susceptibility on Vitek II. On the third day mucoid, cream colour colonies appeared on SDA (Figure 4). Staining with 10% Nigrosin with formaline, showed round budding yeast cells, measuring 5-20 µ in size with distinct large capsule. (Figure 2). The yeast was identified as Cryprococcus laurentii that was resistant to fluconazole, voriconazole, itraconazole and susceptible to amphotericin B by vitek II. The patient was stable for two days but expired third day.
Cryptococcus neoformans/gattii is more commonly associated with infections in immunocompromised patients and sometimes in immunocmpetent hosts [3]. Non C.neoformans / gatti infections are on rise and have been reported several occasions.
C.laurentii infection in HIV positive patient [1]:
C. laurentii in HIV infected patient with low CD4 count-Shankar et al described a case of pneumonia with pleural effusion due to C.laurentii in HIV positive patient. The C.laurentii was also isolated from pleural effusion indicating the involvement of C.laurentii in the pathogenesis of pleural effusion.
C.laurentii infection patient of CRF on CAPD [10]:
Marina Asano et al described a case of Successful Treatment of Cryptococcus laurentii Peritonitis in a Patient on Peritoneal Dialysis. Patient on peritoneal dialysis developed infection with C.laurentii who was treated successfully with voriconazole and removal of the catheter.
C.laurentii infection in non HIV patient [11]:
Miriams T. Castro-Lainez et al presented a case of Cryptococcus laurentii meningitis in a non-HIV patient. The patient was having history of exposure to pigeon droppings and was working at agriculture fields.
C.laurentii in patient with malignancy and on chemotherapy [16]:
A patient with cervical cancer who had received aggressive chemotherapy developed blood steam infection (fungaemia) with C.laurentii as decribed by Rejane Pereira Nevesa et al.
Cuteneous C.laurentii infection [18]:
Alejandro Molina-Leyv et al havereported cutaneous Cryptococcus laurentii infection in an immunocompetent child. The C.laurentii was isolated from skin lesion with limited skin involvement without any visceral or disseminated infection.
C.laurentii Lung abscess infection [22]:
Lynch JP 3rd et al described a pulmonary infection with Cryptococcus laurentii occurred in a patient with dermatomyositis receiving corticosteroid therapy. The isolate was susceptible to amphotericin B but resistant to 5-fluorocytosine, and synergism could not be demonstrated with these 2 drugs. Amphotericin B without surgical resection, concurrent with reduction in the dosage of corticosteroids, resulted in clinical and roentgenogrphic resolution of the infection.
In the present case bronchiectasis was the only obvious predisposing factor for colonization and subsequent disease development as the patient did not have any signs or symptoms suggestive of immunodeficiency and the serology for HIV was negative.
C.laurentii is well known bio-control yeasts reported to reduce postharvest fungal disease of fruits and vegetables [1]. This report raises several questions regarding probable virulence factors of Cryptococcus laurentii, the environmental exposure of people to the Cryptococcus organisms, the role of individual innate immunity and the other host factors in the development of the disease.
As has been described earlier the localized cryptococcal infections can disseminate hematogenously. The correlation between C.laurentii infection and its haematogenous spread to the CNS in development of quadriperesis in this patient remains unexplored due to death of the patient.
Lower respiratory infection due to Cryptococcus laurentii in non-daibetic, HIV negative patient is rare but significant. Generally yeasts in sputum specimen are considered as normal oral flora and not processed unless asked for by a clinician. The present case suggests importance of careful examination of morphology, especially the size and presence of capsule, when yeasts are present predominantly in association with neutrophils in a clinical specimen. The culture and susceptibility could be yielding especially in absence of any other associated pathogen.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
